Prior Authorizations are Becoming the Norm

Leigh Carpenter, RPh, Director of Pharmacy

Most insurance plans require prior authorizations when filling factor prescriptions. A prior authorization (PA) is a process used by health insurance companies to determine if they will pay for a prescribed procedure, service, or medication. The process is intended to act as a safety and cost-saving measure, although it has received criticism from healthcare providers for being costly and time-consuming.

The duration of PAs can vary. Some companies issue a PA for one year, others are for six months, while still others issue them for only one month. The turnaround time to obtain a PA varies as well, depending on the insurance company. Most require copies of clinical notes from your most recent HTC visit. It could take up to 4 days for the pharmacy to receive the authorization.

We need your help to be proactive and to order early. This is especially true if you are changing products—such as switching from a standard half-life product to an extended half-life product. When placing a factor order, our staff may alert you of the need for a PA. If you ever have any questions about this process, please contact Erica Daniels in the HoG office (770) 518-8272 and she will be happy to assist you.